Hot , cold, depleted or deluded

Hot , Cold, Depleted or Deluded?Understanding and accepting Chinese breastfeeding beliefs

Kelly Dombroski

The Study: Background• PhD thesis on mothering practices

in the northwest Chinese city of Xining• Economic activities of mothers• Nappy-free baby hygiene• Infant feeding• Embodied knowledge

• Australian cohort practicing a version of nappy-free hygiene/early infant toileting

• Qualitative research, Human Geography

The Study: Findings Summary (Infant feeding)

• Women in Xining influenced by two main discourses• Traditional Chinese Medicine• Biomedicine

• Equally ‘universalistic’• Both discourses claim to fully

support breastfeeding• Yet their interactions seem to

result in reduced breastfeeding

The Study: Analysis

Research question for this paper:Why do two perspectives fully

supporting breastfeeding interact to produce less breastfeeding?

AndWhat are some strategies we

can engage to address this?

“Health and disease are directly associated with the balance of yin and yang

… yin represents the passive and receding aspect of nature whereas yang represents the active, advancing aspects of nature. It is believed that yin and yang exist at the emotional, physical, interpersonal/ societal, and ecological levels

… the two forces are thought to be interdependent, and the imbalance between them results in disease.” (Chen and Swartzman, 2001: 391)

Traditional Chinese Medicine

Wood Fire Earth Metal Water

Yang Organ

Liver Heart Spleen Lung Kidney

Yin organ Gall bladder

Small Intestine

Stomach Large intestine

Bladder

Senses Eye Tongue Mouth Nose Ear

Tissue Sinews Blood vessels

Muscles Skin Bone

Climatic qi

Wind Heat Damp Dryness Cold

Flavours Sour Bitter Sweet Pungent Salty

Emotions Anger Joy Worry Grief Fear

Traditional Chinese Medicine cont.Table 1: Sample of inter-relating concepts and processes according to TCM

Source: Author, after Men and Guo, 2010

• Breastmilk pure, perfectly digestible• Important not to overburden immature

digestive system • Breastmilk produced via the blood system• But can be affected by changes in qi

TCM and Breastmilk

• Breastfeeding should be initiated in the delivery room ‘if mother and baby are both healthy’• Yet most of my participants delayed by

1-2 days.• Healthy? Rare – birth ‘depletes’ a

mother• This depletion affects her milk – can in

turn deplete the baby• Who judges depletion?

Mother/grandmother. Blood loss, cold, c-sections, trauma, anxiety = delayed feeding

TCM and the first breastfeed

• TCM = delayed first feed. Few problems traditionally – could be up to 3 days while mother recovers.

• Biomedicine concern babies will become hypoglycemic and unable to feed – some actual cases especially in rural areas.• Treated with sugar water (spooned)

• TCM + Bio = conceptual opening for non-breastmilk substances.• Artificial formula means baby will not be

hypoglycemic, mother will have chance to recover.

TCM and Biomedicine: First feed

• Strategies:• Negotiating delay in first feed?• Providing or suggesting blood

nourishing foods, especially for c-section or traumatised women.

• Being respectful of women’s concern for her health as well as the health of the baby.

• Getting grandmother and husband on side – demonstrate your desire to balance the health of mother and baby

TCM and Biomedicine: First feed

• Suggested sentences:“How do you feel?’ Listen for words like

‘depleted’ ‘drained’ ‘tired’ “You have lost some blood, so let’s make

sure you get the nourishing food you need. Do you have someone to bring food in for you?”

“You have been through a pretty draining experience, make sure you take some rest and recover your body, and in a while we will try to feed baby a little”

“We need to balance your needs for recovery with baby’s need for sucking “

TCM and Biomedicine: First feed

TCM: Blood, milk and nourishment as baby grows

• Milk quality and quantity related to both blood and qi

• ‘Bad’ milk related to ill health, emotional states, seasonal changes in milk• ‘bad’ can refer to both quality and

quantity• Self-diagnosed through

• baby’s behaviour (unsettled, hungry signs, vomiting, abdominal pain, continuous feeding)

• Mother’s feeling (anxious, uncomfortable, empty)

• Treated through nourishing foods, rest, counselling

TCM and Biomedicine: nourishment as baby grows

• TCM= low supply/bad milk exists and can be easily treated through diet, rest, acupuncture, herbs

• Biomedicine= low supply/bad milk does not/rarely exists. Just feed the baby more frequently.

• TCM + Biomedicine = gap for breastmilk substitutes• Woman feels there is a milk quality or

quantity problem but is offered no treatment options bar ‘more feeding’

• Often results in supplementing with formula (sometimes temporary)

TCM and Biomedicine: nourishment as baby grows

Strategies:• Recognising the felt needs of the mother,

and balancing these with baby.• Talk about feelings – shock, anxiety, anger

are particularly relevant. Refer for counselling. Enquire about support.

• Suggestions for boosting supply – rest, protein (particularly lamb), refer to TCM practitioner/acupuncturist

• Aware of foods that cause discomfort in baby – TCM has lists of foods that can unsettle baby (mother’s diet or baby’s diet). Similar to common allergy foods (wheat, dairy, salicylates) and gassy foods (certain vegetables and pulses)

TCM and Biomedicine: nourishment as baby grows

Suggested sentences:• Ask how she knows her supply or quality

is being affected – listen for words like ‘anxious’, ‘unsettled’ , ‘crying’, ‘empty’

• ‘Being a mum can be pretty tiring and worrying – have you been worried about anything lately?’

• ‘Babies have sensitive tummies, is there anything you are eating that could be unsettling baby?’

• ‘I prescribe you (period of time) rest. I want you to rest in bed with baby every afternoon, and just concentrate on recovering from your illness and feeding baby – resting will help restore your supply.’

TCM, Biomedicine, and Breastfeeding• Differences primarily differences in how

one ‘knows’ not in the quality of information or education.

• Breastfeeding is a deeply embodied experience, and listening to what women are feeling is very important.

• Women from Chinese backgrounds may be drawing on quite different bodily experiences and knowledge traditions.

• Ignoring or belittling these can lead to breastfeeding failure or early weaning.

• Respecting and working with these can lead to breastfeeding success.

ABA and TCM• ABA is not a medical organisation – it is

primarily a support organisation• Medical research does not (and cannot)

cover many aspects of the embodied breastfeeding relationship

• TCM has a long history, and will probably not be replaced by biomedicine

• We should be supporting breastfeeding relationships pragmatically and not dogmatically, whatever the cultural or medicinal tradition of our subscribers.